What should we do after resected colonic diminutive polyps?

Objectives: We aimed to evaluate the histopathological features of diminutive polyps and to find an answer to the question about the post-resection management of these polyps. Materials and methods: Between January 2017 and February 2022 a total of 1,768 patients (796 males, 972 females; mean age: 59.8±12.2 years; range, 31 to 89 years) who underwent colonoscopy were evaluated retrospectively, and included in the study. Data on the patient’s demographics, colonoscopy, and pathology results, as well as the location, size, and histopathological characteristics of the polyps, were all recorded on the registration form. After the polyps were classified according to their size and localization, they were recorded together with their histopathological features and, statistical analysis was performed. Results: A total of 343 polyps were detected in 230 (13%) patients. Two hundred sixty (76%) of these polyps were diminutive polyps. When evaluated according to their localization, diminutive polyps were most common in the rectosigmoid region (53.8%) and least in the cecum (5%). 62.7% of diminutive polyps were non-neoplastic (hyperplastic) polyps. As for advanced histopathological features of adenomatous polyps, 2.3% had a villous component, while none of the polyps had dysplasia. Conclusion: In our study, most of the diminutive polyps were non-neoplastic, while those in the neoplastic group had very few advanced histopathological features and no carcinoma was present in any of the polyps. There were no advanced histological findings in any of the polyps, particularly in the rectosigmoid region. In conclusion, we believe that removal of diminutive polyps in the rectosigmoid region without optical chromoendoscopy or histopathological examination can be cost-effective and reliable.